title: Compound elevated skull fracture: a clinical series of three patients with a review of the literature.
abstract: OBJECTIVE
  Compound elevated fracture of the skull is an unusual variety of fracture of the cranial vault that has been rarely described in the currently available literature. The authors describe three such patients with post-traumatic compound elevated skull fracture. The pertinent literature is reviewed, the injury mechanism is highlighted and the management issues are discussed in detail.
  
  
  METHODS
  All three patients in this series presented with elevation of free skull fracture fragments above the surface. The mode of injury was rail accident in two patients and injury by a rapidly moving crane in one patient. Two patients had dural laceration with extrusion of brain matter through the dural defect. The remaining patient had an elevated fracture fragment simulating a formal craniotomy with an intact dura. The patient who suffered crane injury was brought dead. Surgery was performed in remaining two patients. Wound debridement and duraplasty was performed. Both patients received broad-spectrum antibiotics in anti-meningitic doses. Both of these patients did well after surgery.
  
  
  CONCLUSIONS
  Elevated skull fractures are usually compound injuries. High velocity tangential impact to the skull vault is the most likely causative mechanism in such type of injury. Delay in surgery could lead to intracranial sepsis including meningitis and brain abscess. Thus, these fractures should be aggressively treated.
authors.affiliation: All India Institute of Medical Sciences, Department of Neurosurgery, New Delhi, India.
authors.forename: Sachin Anil
authors.initials: SA
authors.lastname: Borkar
authors.forename: G L
authors.initials: GL
authors.lastname: Prasad
authors.forename: D K
authors.initials: DK
authors.lastname: Gupta
authors.forename: Sumit
authors.initials: S
authors.lastname: Sinha
authors.forename: A K
authors.initials: AK
authors.lastname: Mahapatra
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001930:Brain Injuries / Q000209:etiology; D006259:Craniocerebral Trauma / Q000150:complications; D017809:Fatal Outcome; D005597:Fractures, Open / Q000601:surgery; D015600:Glasgow Coma Scale; D006801:Humans; D016920:Meningitis, Bacterial / Q000517:prevention & control; D019635:Neurosurgical Procedures; D010291:Paresis / Q000209:etiology; D012121:Respiration, Artificial; D012887:Skull Fractures / Q000209:etiology / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D014139:Tracheostomy; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents